Broker End of Day Pricing Request Form

1. First name *  
2. Last name *  
3. Business email *
   *Only official company email address is accepted. Please do not use group or personal email addresses.    
4. Company name *  
5. Address line 1 *  
6. Address line 2
7. City *  
8. State/County/Province
9. Zip/Postcode
10. Country Select Country United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe *  
11. Telephone number *  
12. Function *
    (Trader/Marketing/Operation/Research and Analysis/Risk/Technology/Finance/Chartering/Others) Please indicate one.  


13. Job title *  
14. Do you trade with Tullett Prebon? select: Yes No *  
15. Name of TP broker *
    If not applicable, please enter "None"  
16. Traded product(s) *
    If not applicable, please enter "None"  

1. Name of file requested *  
2. Will the data be used by your back office? select: Yes No *  
3. Will the data be used in an application? select: Yes No *    
4. If yes, application name:
5. If yes, application type:
6. Please explain the intended use of this data: *  

NOTICE TO END USER: PLEASE READ CAREFULLY.

End User Certifies on behalf of Company that:

a) The end of day pricing information ("Information") is used exclusively by traders identified on the Tullett Prebon Broker End of Day Pricing Request Form ("Form") that deal with Tullett Prebon Information Limited's broking affiliates ("Identified Traders") within the Tullett Prebon Group of companies (collectively "Tullett Prebon") and shall not be shared with or distributed to any End User's middle or back office area for any purpose, including for use in connection with any risk, valuation, or any other pricing applications;

b) The Information is used only for the purpose of supporting the activities of the Identified Trader with Tullett Prebon and the data is not used for other purposes including without limitation supporting trading with competitors of Tullett Prebon;

c) Neither End User Identified Trader, nor any of its employees or agents will sell, lease, furnish, redistribute, retransmit, or otherwise permit or provide access to the information or any data created from the information through manipulation, modification, supplementation, enhancement or combining with other information ("Derivative Works") to any person other than the Identified Trader;

d) The Information or any Derivative Works may not be used in any software applications of other systems accessible by any party other than the Identified Trader and only where such systems or software are front office systems supporting the trader's activities with Tullett Prebon; and

e) Neither End User Identified Trader, nor any of its employees or agents will use the information or any Derivative Works in any products or services that the End User or any employees or agents of the End User provides to any third party, including, but not limited to, portfolio valuation, securities valuation and risk evaluation services.

This communication is provided by TP ICAP Group plc and/or one of its group companies ("TP ICAP") and by providing this communication, TP ICAP provides a personal, non-exclusive, non-transferable, non-sublicensable, revocable and limited licence to use the information contained in or attached to this communication (including, but not limited to indicative prices/levels or other data) (the "Information") for informational purposes only. Access to the Information by anyone other than the intended recipient is unauthorised without TP ICAP's prior written approval. The Information may not be used or disclosed for any purpose, without TP ICAP's prior written approval, including without limitation, storing, copying, distributing, licensing, selling or displaying the Information, using the Information in an application or to create derived data, indices or benchmarks or co-mingling the Information with any other data ("Unlicensed Use").

The Information is not, and should not be construed as, a live price, an offer, bid, recommendation or solicitation in relation to any financial instrument or investment or to participate in any particular trading strategy. The Information is not to be relied upon for any purpose and is not warranted, either expressly or by implication, as to completeness, timeliness, accuracy, continuity, merchantability or fitness for any particular purpose. All representations and warranties are expressly disclaimed, to the fullest extent possible under applicable law. In no circumstances will TP ICAP be liable for any indirect or direct loss, or consequential loss or damages including without limitation, loss of business or profits arising from the use of, any inability to use, or any inaccuracy in the Information. TP ICAP may suspend, withdraw or modify or change the terms of the provision of the Information at any time in its sole discretion, without notice.

By accessing the Information you will be deemed to warrant and undertake that you will not use the Information for any Prohibited Use or Unlicensed Use. The terms of this disclaimer are governed by the laws of England and Wales.